DRAFT ACA Anniversary Slides

24 Pages·2016·0.36 MB·English

by  Siegler, Matthew

The Economic Record of the
Obama Administration:
Reforming the Health Care System
Council of Economic Advisers
December 13, 2016
I. Expanding and Improving Health
Insurance Coverage
Uninsured Rate Has Fallen to the Lowest Level Ever
Share of Population Without Health Insurance
Percent
25
Creationof
ACA 1stOpen
Medicare &
Enrollment
Medicaid
20
15
10
2016
5
0
1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015
Because of the Affordable Care Act, 20 million adults have gained health insurance coverage. The
coverage gains since the end of 2013 are the most rapid since the decade following the creation of
Medicare and Medicaid, and the uninsured rate is now below 9 percent, the lowest level ever.
Source: National Health Interview Survey and supplemental sources described in CEA (2014). 3
Note: Estimate for 2016 reflects only the first two quarters. Other estimates reflect the full year.
The Uninsured Rate Among Children Has Fallen by Nearly Half Since 2008
Uninsured Rates by Age, 1997-2016
Percent uninsured
25
CHIP YearPrior Year Before
Created to CHIPRA First ACA Open
Enactment Enrollment
Non-Elderly Adults,
20
except Young Adults (26-64)
15
Children (<19)
2016
10
5
0
1997 1999 2001 2003 2005 2007 2009 2011 2013 2015
Because of the decline in the uninsured rate for children since 2008, more than 3 million additional
children have health insurance coverage in 2016. The increase in insurance coverage among children
reflects, in large part, improvements to the Children’s Health Insurance Program enacted in the
President’s first month in office and the broader ACA coverage expansions that took effect in 2014.
Source: National Health Interview Survey; CEA calculations.
Note: Estimates for 2016 reflect only the first two quarters. Estimates of the uninsured rate for 0-18 year olds have not yet been reported for 2016, so the reported uninsured rate for 0-18 year
olds was calculated by extrapolating the 2015 estimate using the percentage point change for 0-17 year olds. Similarly, estimates of the uninsured rate for 26-64 year olds were extrapolated
4
using the percentage point change for the larger group consisting of 18 year olds and 26-64 year olds.
The Young Adult Uninsured Rate Has Fallen
by More Than Half Since 2010
Uninsured Rates by Age, 1997-2016
Percent uninsured
40
ACA First ACA
Young Adults (19-25) Dependent Open
35
Coverage Enrollment
Expansion
30
25
Other Non-Elderly Adults (26-64)
20
15
10
2016:Q2
5
0
1997 1999 2001 2003 2005 2007 2009 2011 2013 2015
The uninsured rate among young adults ages 19-25 has fallen by 53 percent through the second quarter
of 2016. Young adults have benefited both from the option to remain on a parent’s plan until age 26 and
from the law’s broader coverage expansions through Medicaid and the Health Insurance Marketplaces.
Source: National Health Interview Survey; CEA calculations.
Note: The reported percent decline reflects the percent change from the four quarters before the ACA’s dependent coverage provision took effect (2009:Q4-2010:Q3) through 2016:Q2.
Estimates of the uninsured rate for 26-64 year olds have not yet been reported for 2016, so the reported uninsured rates for 26-64 year olds were calculated by extrapolating the 2015
5
estimate using the percentage point changes for the larger group consisting of 18 year olds and 26-64 year olds.
States that Expanded Their Medicaid Programs Have Seen
Much Larger Gains in Health Insurance Coverage
Decline in Uninsured Rate from 2013 to 2015
vs. Level of Uninsured Rate in 2013, by State
Decline in uninsured rate from 2013 to 2015 (percentage points)
10
9
8
7 Medicaid Expansion States
6
5
4
3
2
Medicaid Non-Expansion States
1
0
0 2 4 6 8 10 12 14 16 18 20 22 24
Uninsured rate in 2013 (percent)
While all states have seen insurance coverage gains since 2013, Medicaid expansion states have seen
much larger gains, despite starting with lower uninsured rates. Medicaid expansion states that had
relatively high uninsured rates in 2013 have seen the largest gains. If all states that have not yet expanded
their Medicaid programs did so, an additional 4 million people would gain health insurance.
Source: American Community Survey; CEA calculations.
6
Note: States are classified by Medicaid expansion status as of July 1, 2015.
Insurance Coverage Has Risen at All Income Levels
Non-Elderly Uninsured Rate by Income
Percent uninsured
40
36% reduction 2013 2015
28.7
30
33% reduction
19.3
18.3
20
13.0
31% reduction
10
4.7
3.2
0
< 138 138 to 400 > 400
Income as a Percent of the Federal Poverty Level
The uninsured rate has declined in all income groups since 2013. Coverage gains above the Medicaid
eligibility threshold of 138 percent of the Federal Poverty Level show that the ACA’s interlocking reforms
to the individual health insurance market—banning discrimination based on pre-existing conditions,
providing financial assistance to make coverage affordable, and implementing an individual responsibility
provision—are working to increase insurance coverage.
7
Source: National Health Interview Survey; CEA calculations
Coverage Gains Under the ACA Have Been Broad-Based
Uninsured Rates by Population Group
By Race and Ethnicity By Urban/Rural and ExpansionStatus
Percent uninsured Percent uninsured
50 25
2010 2015 2010 2015
40
20
30
15
20
10
10
5
0
White Hispanic Black Native Asian Multiple 0
American Races Urban Rural Urban Rural
Race/Ethnicity Expansion States Non-Expansion States
The uninsured rate has declined in a wide range of population groups, including all racial and ethnic
groups and people living in both urban and rural areas. Among racial and ethnic groups, gains in
insurance coverage have been largest for groups with the largest uninsured rates in 2010, indicating that
recent years’ coverage gains are helping to reduce economic disparities.
Source: National Health Interview Survey; American Community Survey; CEA calculations.
Note: Estimates by race and ethnicity were calculated using National Health Interview Survey. Estimates by geography were calculated using the American Community Survey, which provides
more detailed geographic breakdowns. Counties inside a metropolitan statistical area were categorized as urban and all others as rural. Medicaid expansion status is as of July 1, 2015. 8
Expanded Coverage is Improving Access to Care,
Financial Security, and Health
Decline in Share Not Seeing a Doctor Due to Cost
vs. Decline in Uninsured Rate, by State, 2013-2015
Decline in share not seeing a doctor due to cost, 2013-2015 (p.p.)
7
6
5
4
3
2
1
0
-1
0 2 4 6 8 10 12 14
Decline in uninsured rate, 2013-2015 (p.p.)
A growing body of evidence shows that broader insurance coverage is improving access to care,
financial security, and health. These findings are consistent with research examining earlier, similar
coverage expansions. If experience matches what was observed under Massachusetts health reform,
24,000 deaths are already being avoided annually because of expanded coverage under the ACA.
Source: Behavioral Risk Factor Surveillance System; CEA calculations.
9
Note: Sample limited to non-elderly adults.
Broader Insurance Coverage is Reducing Uncompensated Care
Uncompensated Care as a Share of Hospital Costs
Percent of hospital operating costs
6
Medicaid Non-Expansion States
5
4
All States
3
Medicaid Expansion States
2
2015
1
0
2011 2012 2013 2014 2015
Uncompensated care as a share of hospital costs has fallen by more than a quarter since 2013. Medicaid
expansion states have seen even larger declines, with uncompensated care as a share of hospital costs
falling by almost half over that period. The nationwide decline corresponds to a reduction in hospital
uncompensated care costs of $10.4 billion in 2015.
Source: Centers for Medicare and Medicaid Services, Hospital Cost Reports; CEA calculations.
10
Note: State Medicaid expansion status is as of July 1, 2015. Data for 2015 are incomplete.